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1.  The literature of medical ethics: A review of the writings of Hans Jonas 
Journal of Medical Ethics  1976;2(1):39-43.
Hans Jonas, who was trained in Germany in the 1920s as a philosopher, had written studies of gnosticism while still living in Germany and some of his work in that field was published after he had left the country. After the Second World War Jonas settled in the United States of America where he is now the Alvin Johnson Professor of Philosophy at the New School for Social Research in New York City. For some years Hans Jonas has directed his research to philosophical studies of medical ethics, in particular to the problems created by recent advances in medical technology. His first book on this theme, `The Phenomenon of Life: Towards a Philosophical Biology', provides the philosophical background to his latest studies and was published in 1966. The essays included in that volume date from 1950 onwards. His second, `Philosophical Essays: From Ancient Creed to Technological Man', continues his analysis and argument from 1964 to the present day but is more particularly concerned with the practical problems of medical ethics encountered by clinicians and research workers, for example, experiments on comatose patients. Dr Cooper in this review outlines in some detail the theses of these volumes.
PMCID: PMC2495113  PMID: 784996
2.  Beyond voluntary consent: Hans Jonas on the moral requirements of human experimentation. 
Journal of Medical Ethics  1993;19(2):99-103.
In his essay, Philosophical Reflections on Experimenting with Human Subjects, Hans Jonas contends that except in cases of widespread medical emergencies, people do not have a moral or social obligation to volunteer to be subjects in medical experiments. He further argues that any appeal for volunteer subjects in medical experiments should whenever possible give priority to those who can identify with the project and offer a strong sense of commitment to its goals. The first of these claims is given support against some recent criticisms, but argument is offered to show that the second claim not only does little to enhance the stature of the standard requirement of free and informed consent but may even weaken the moral validity of the consent.
PMCID: PMC1376196  PMID: 8331645
3.  Psychosomatic medicine and the philosophy of life 
Basing ourselves on the writings of Hans Jonas, we offer to psychosomatic medicine a philosophy of life that surmounts the mind-body dualism which has plagued Western thought since the origins of modern science in seventeenth century Europe. Any present-day account of reality must draw upon everything we know about the living and the non-living. Since we are living beings ourselves, we know what it means to be alive from our own first-hand experience. Therefore, our philosophy of life, in addition to starting with what empirical science tells us about inorganic and organic reality, must also begin from our own direct experience of life in ourselves and in others; it can then show how the two meet in the living being. Since life is ultimately one reality, our theory must reintegrate psyche with soma such that no component of the whole is short-changed, neither the objective nor the subjective. In this essay, we lay out the foundational components of such a theory by clarifying the defining features of living beings as polarities. We describe three such polarities:
1) Being vs. non-being: Always threatened by non-being, the organism must constantly re-assert its being through its own activity.
2) World-relatedness vs. self-enclosure: Living beings are both enclosed with themselves, defined by the boundaries that separate them from their environment, while they are also ceaselessly reaching out to their environment and engaging in transactions with it.
3) Dependence vs. independence: Living beings are both dependent on the material components that constitute them at any given moment and independent of any particular groupings of these components over time.
We then discuss important features of the polarities of life: Metabolism; organic structure; enclosure by a semi-permeable membrane; distinction between "self" and "other"; autonomy; neediness; teleology; sensitivity; values. Moral needs and values already arise at the most basic levels of life, even if only human beings can recognize such values as moral requirements and develop responses to them.
doi:10.1186/1747-5341-5-2
PMCID: PMC2823620  PMID: 20089202
4.  ARE HONORS RECEIVED DURING SURGERY CLERKSHIPS USEFUL IN THE SELECTION OF INCOMING ORTHOPAEDIC RESIDENTS? 
The purpose of this study was to review institutional statistics provided in dean's letters and determine the percentage of honors awarded by institution and clerkship specialty.
Institutional and clerkship aggregate data were compiled from a review of dean's letters from 80 United States medical schools. The percentage of honors awarded during 3rd year clerkships during 2005 were collected for analysis. Across clerkship specialties, there were no statistically significant differences between the mean percentage of honors given by the medical schools examined with Internal Medicine (27.6%) the low and Psychiatry (33.5%) the high. However, inter-institutional variability observed within each clerkship was high, with surgery clerkship percentage of honors ranging from 2% to 75% of the students. This suggests some schools may be more lenient and other more stringent in awarding honors to their students. This inter-institutional variability makes it difficult to compare honors received by students from different medical schools and weakens the receipt of honors as a primary tool for evaluating potential incoming residents.
PMCID: PMC2723699  PMID: 19742092
5.  Congenital hip dislocation: an increasing and still uncontrolled disability? 
A study of 178 cases of congenital dislocation of the hip in babies born between 1965 and 1978 in Southampton health district showed that the incidence had virtually doubled over this period. Established cases (persisting beyond the first birthday) had risen to around two cases per 1000 per live births. One-third of these were first diagnosed after the age of 1 year and one-fifth after 18 months. The findings are particularly disappointing as there were opportunities after the neonatal period for earlier diagnosis. Thus, neonatal screening appears to have failed to make a substantial impact on the morbidity of the disease, probably because of a combination of inherent difficulties in the neonatal screening test as well as failure in its proper application. Much greater vigilance is needed during the first year of life if congenital dislocation of the hip is to be detected and treated as early as possible. Perhaps this could be achieved if all health professionals were more aware of the problem and were encouraged to examine hips at every opportunity and health authorities periodically audited their results.
PMCID: PMC1500524  PMID: 6814630
6.  Experimentation with human subjects: a critique of the views of Hans Jonas. 
Journal of Medical Ethics  1983;9(2):76-79.
The ethics of experimentation on human subjects has become the subject of much debate among medical scientists and philosophers. Ethical problems and conflicts of interest become especially serious when research subjects are recruited from the class of patients. Are patients who are ill and suffering in a position to give voluntary and informed consent? Are there inevitable conflicts of interest and moral obligation when a personal physician recruits his own patients for an experiment designed partly to advance scientific knowledge and only partly as therapy for those patients? The views of the eminent American ethicist Hans Jonas on these issues are briefly summarised and criticised, and some moral guidelines are then proposed to regulate experimentation on human subjects.
PMCID: PMC1059345  PMID: 6876101
7.  Patients, doctors and experimentation: doubts about the Declaration of Helsinki. 
Journal of Medical Ethics  1978;4(4):182-185.
The World Medical Association's Declaration of Helsinki offers guidelines to doctors engaged in biomedical research with human subjects. The fundamental distinction of the Declaration is between clinical research combined with professional care and non-clinical scientific research. If hospital patients are the experimental subjects, then the former research must be carried out by the patient's own doctor, whereas the latter research must not be; it must be carried out by other doctors. The relevance of the distinction between the patient's own doctor and other doctors is challenged and an alternative conception of the patient-doctor relationship is drawn, together with an alternative justification, based on the work of Hans Jonas, of the use of patients in research. Finally, the political nature of the patient-doctor relationship is mentioned, and it is claimed that the alternative conception of this relationship developed in the paper is more in line with the ethical principles of the Hippocratic tradition.
PMCID: PMC1154681  PMID: 739514
8.  Fourth goal of perinatal medicine. 
Reduction in maternal mortality, infant mortality, and infant morbidity have been successively the goals of perinatal medicine. The fourth is to reduce bonding failure. In July 1978 a preventive service was started in the John Radcliffe Maternity Hospital. A twice-weekly round is made. Midwives refer families who cause them concern. In the first year the referral rate ws 20.5 per 1000 liveborn babies. The referred sample differed from the hospital population in terms of maternal psychiatric history, marital state and babies' admission to special care. The main reasons for referral were: doubt about parenting ability (27%), psychiatric history (15%), disturbed behaviour in hospital (14%), and diffuse social and medical problems (17%). Long-term care was needed for only 14% of families. At their first birthdays, six babies were placed away from their natural parents; the sample had had a slightly higher than expected admission rate to hospital; the distribution of weights did not differ from the expected; doctors and health visitors were still concerned about one-quarter of the families. Seven cases of screening failure were found among those not referred to our service, but only one was seriously abused. No child referred in the first year has been seriously neglected or abused.
PMCID: PMC1496275  PMID: 6802338
9.  Comparison of Children With Onset of Juvenile Dermatomyositis Symptoms Before or After Their Fifth Birthday in a UK and Ireland Juvenile Dermatomyositis Cohort Study 
Arthritis Care & Research  2012;64(11):1665-1672.
Objective
To compare 2 groups of children with juvenile dermatomyositis (DM), those with onset of symptoms before their fifth birthday versus those whose disease begins either on or after their fifth birthday, and to assess whether age at onset is associated with differences in disease presentation, treatments received, or outcomes 2 years after diagnosis.
Methods
Data were analyzed on children recruited to a UK juvenile DM cohort study with a diagnosis of probable or definite juvenile DM and less than 12 months between diagnosis and recruitment.
Results
Fifty-five (35%) of 157 children had onset of symptoms before their fifth birthday. At diagnosis, cutaneous ulceration was found in 32.7% of the younger group versus 11.8% of the older group (P = 0.003). Facial or body swelling was reported more often in the younger group, whereas headaches, alopecia, and Raynaud's phenomenon were all more frequently reported in the older group. At followup 2 years later, there were no important differences in outcomes between the groups. More than 90% of patients in both groups received both methotrexate and steroids. Twenty-three percent of both groups remained on steroids 2 years after diagnosis.
Conclusion
Our study showed that children with juvenile DM with disease onset at age <5 years are more likely to present with ulcerative skin disease and edema. There were no clinically significant differences in outcomes between the 2 groups.
doi:10.1002/acr.21753
PMCID: PMC3533762  PMID: 22674907
10.  Association Between Prepartum Maternal Iron Deficiency and Offspring Risk of Schizophrenia: Population-Based Cohort Study With Linkage of Danish National Registers 
Schizophrenia Bulletin  2010;37(5):982-987.
Recent findings suggest that maternal iron deficiency may increase the risk of schizophrenia-spectrum disorder in offspring. We initiated this study to determine whether maternal prepartum anemia influences offspring risk of schizophrenia. We conducted a population-based study with individual record linkage of the Danish Civil Registration System, the Danish Psychiatric Central Register, and the Danish National Hospital Register. In a cohort of 1 115 752 Danish singleton births from 1978 to 1998, cohort members were considered as having a maternal history of anemia if the mother had received a diagnosis of anemia at any time during the pregnancy. Cohort members were followed from their 10th birthday until onset of schizophrenia, death, or December 31, 2008, whichever came first. Adjusted for relevant confounders, cohort members whose mothers had received a diagnosis of anemia during pregnancy had a 1.60-fold (95% confidence interval = 1.16–2.15) increased risk of schizophrenia. Although the underlying mechanisms are unknown and independent replication is needed, our findings suggest that maternal iron deficiency increases offspring risk of schizophrenia.
doi:10.1093/schbul/sbp167
PMCID: PMC3160221  PMID: 20093425
Schizophrenia; epidemiology; risk factor; Denmark; maternal iron deficiency; follow-up; cohort
11.  THE SCOPE AND RESPONSIBILITY OF MEDICINE—A Forum with a Purpose 
California Medicine  1968;109(5):413-415.
To engender discussion of what the scope and responsibility of medicine ought to be in today's society, California Medicine printed in its June issue six essays by authors known to have keen if various interest in the subject.
In presenting the essays the editors expressed hope that they would be the beginning of a forum from which a definition of our profession's responsibilities may be distilled. Readers were invited to take part in a continuation of the forum in succeeding issues. Following are three contributions selected from those received to date. Others will be published in the months ahead.
If you have thoughts on the subject, just address them to the editors of California Medicine, 693 Sutter Street, San Francisco, California 94102. Keep your essays short, please.
PMCID: PMC1503365  PMID: 18730160
12.  THE SCOPE AND RESPONSIBILITY OF MEDICINE—A Forum with a Purpose 
California Medicine  1968;109(3):238-239.
To engender discussion of what the scope and responsibility of medicine ought to be in today's society, California Medicine printed in its June issue six essays by authors known to have keen if various interest in the subject.
In presenting the essays the editors expressed hope that they would be the beginning of a forum from which a definition of our profession's responsibilities may be distilled. Readers were invited to take part in a continuation of the forum in succeeding issues. Following are three contributions selected from those received to date. Others will be published in the months ahead.
If you have thoughts on the subject, just address them to the editors of California Medicine, 693 Sutter Street, San Francisco, California 94102. Keep your essays short, please.
PMCID: PMC1503215  PMID: 18730147
13.  THE SCOPE AND RESPONSIBILITY OF MEDICINE—A Forum with a Purpose 
California Medicine  1968;109(2):168-171.
To engender discussion of what the scope and responsibility of medicine ought to be in today's society, California Medicine printed in its June issue six essays by authors known to have keen if various interest in the subject.
In presenting the essays the editors expressed hope that they would be the beginning of a forum from which a definition of our profession's responsibilities may be distilled. Readers were invited to take part in a continuation of the forum in succeeding issues. Following are three contributions selected from those received to date. Others will be published in the months ahead.
If you have thoughts on the subject, just address them to the editors of California Medicine, 693 Sutter Street, San Francisco, California 94102. Keep your essays short, please.
PMCID: PMC1503182  PMID: 18730140
14.  THE SCOPE AND RESPONSIBILITY OF MEDICINE—A Forum with a Purpose 
California Medicine  1968;109(4):332-333.
To engender discussion of what the scope and responsibility of medicine ought to be in today's society, California Medicine printed in its June issue six essays by authors known to have keen if various interest in the subject.
In presenting the essays the editors expressed hope that they would be the beginning of a forum from which a definition of our profession's responsibilities may be distilled. Readers were invited to take part in a continuation of the forum in succeeding issues. Following are two contributions selected from those received to date. Others will be published in the months ahead.
If you have thoughts on the subject, just address them to the editors of California Medicine, 693 Sutter Street, San Francisco, California 94102. Keep your essays short, please.
PMCID: PMC1503252  PMID: 5696562
15.  THE SCOPE AND RESPONSIBILITY OF MEDICINE—A Forum with a Purpose 
California Medicine  1968;109(1):50-52.
To engender discussion of what the scope and responsibility of medicine ought to be in today's society, California Medicine printed in its June issue six essays by authors known to have keen if various interest in the subject.
In presenting the essays the editors expressed hope that they would be the beginning of a forum from which a definition of our profession's responsibilities may be distilled. Readers were invited to take part in a continuation of the forum in succeeding issues. Following are four contributions selected from those received to date. Others will be published in the months ahead.
If you have thoughts on the subject, just address them to the editors of California Medicine, 693 Sutter Street, San Francisco, California 94102. Keep your essays short, please.
PMCID: PMC1503153  PMID: 5662567
16.  The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness 
BMC Infectious Diseases  2012;12:158.
Background
Urinary tract infection (UTI) is common in children, and may cause serious illness and recurrent symptoms. However, obtaining a urine sample from young children in primary care is challenging and not feasible for large numbers. Evidence regarding the predictive value of symptoms, signs and urinalysis for UTI in young children is urgently needed to help primary care clinicians better identify children who should be investigated for UTI. This paper describes the protocol for the Diagnosis of Urinary Tract infection in Young children (DUTY) study. The overall study aim is to derive and validate a cost-effective clinical algorithm for the diagnosis of UTI in children presenting to primary care acutely unwell.
Methods/design
DUTY is a multicentre, diagnostic and prospective observational study aiming to recruit at least 7,000 children aged before their fifth birthday, being assessed in primary care for any acute, non-traumatic, illness of ≤ 28 days duration. Urine samples will be obtained from eligible consented children, and data collected on medical history and presenting symptoms and signs. Urine samples will be dipstick tested in general practice and sent for microbiological analysis. All children with culture positive urines and a random sample of children with urine culture results in other, non-positive categories will be followed up to record symptom duration and healthcare resource use. A diagnostic algorithm will be constructed and validated and an economic evaluation conducted.
The primary outcome will be a validated diagnostic algorithm using a reference standard of a pure/predominant growth of at least >103, but usually >105 CFU/mL of one, but no more than two uropathogens.
We will use logistic regression to identify the clinical predictors (i.e. demographic, medical history, presenting signs and symptoms and urine dipstick analysis results) most strongly associated with a positive urine culture result. We will then use economic evaluation to compare the cost effectiveness of the candidate prediction rules.
Discussion
This study will provide novel, clinically important information on the diagnostic features of childhood UTI and the cost effectiveness of a validated prediction rule, to help primary care clinicians improve the efficiency of their diagnostic strategy for UTI in young children.
doi:10.1186/1471-2334-12-158
PMCID: PMC3575241  PMID: 22812651
Urinary Tract Infection; Children; Primary care; Point-of-care-test; Dipstick test; Near-patient testing; Diagnosis; Economic models
17.  Can breastfeeding promote child health equity? A comprehensive analysis of breastfeeding patterns across the developing world and what we can learn from them 
BMC Medicine  2013;11:254.
Background
In 2010 more than 7.7 million children died before their fifth birthday. Over 98% of these deaths occurred in developing countries, and recent estimates have attributed hundreds of thousands of these deaths to suboptimal breastfeeding.
Methods
This study estimated prevalence of suboptimal breastfeeding for 137 developing countries from 1990 to 2010. These estimates were compared against WHO infant feeding recommendations and combined with effect sizes from existing literature to estimate associated disease burden using a standard comparative risk assessment approach. These prevalence estimates were disaggregated by wealth quintile and linked with child mortality rates to assess how improved rates of breastfeeding may affect child health inequalities.
Results
In 2010, the prevalence of exclusive breastfeeding ranged from 3.5% in Djibouti to 77.3% in Rwanda. The proportion of child Disability Adjusted Life Years (DALYs) attributable to suboptimal breastfeeding is 7.6% at the global level and as high as 20.2% in Swaziland. Suboptimal breastfeeding is a leading childhood risk factor in all developing countries and consistently ranks higher than water and sanitation. Within most countries, breastfeeding prevalence rates do not vary considerably across wealth quintiles.
Conclusions
Breastfeeding is an effective child health intervention that does not require extensive health system infrastructure. Improvements in rates of exclusive and continued breastfeeding can contribute to the reduction of child mortality inequalities in developing countries.
doi:10.1186/1741-7015-11-254
PMCID: PMC3896843  PMID: 24305597
Breastfeeding; Health inequity; Child health; Global burden of disease; Infant feeding
18.  Current status of poliovirus infections. 
Clinical Microbiology Reviews  1996;9(3):293-300.
Two scientists who played leading roles in the conquest of poliomyelitis died recently. In 1954, Jonas Salk provided the first licensed polio vaccine, the formalin (and heat)-inactivated virus. Albert Sabin gave us the attenuated live virus vaccine, which was licensed in 1962. This paper takes the reader through the history of the disease, including its pathogenesis, epidemiology, vaccines, and future directions. The emphasis is on vaccines, for it seems that with proper vaccination the number of new cases is falling dramatically. It is hoped that by the year 2000, we will accomplish the goal of the World Health Organization of "a world without polio." Then, because there is no animal reservoir, we can seriously discuss when and how to eliminate the need for vaccination and ultimately destroy our stocks of poliovirus.
PMCID: PMC172894  PMID: 8809461
19.  The invention of the psychosocial: An introduction 
History of the Human Sciences  2012;25(5):3-12.
Although the compound adjective ‘psychosocial’ was first used by academic psychologists in the 1890s, it was only in the interwar period that psychiatrists, psychologists and social workers began to develop detailed models of the psychosocial domain. These models marked a significant departure from earlier ideas of the relationship between society and human nature. Whereas Freudians and Darwinians had described an antagonistic relationship between biological instincts and social forces, interwar authors insisted that individual personality was made possible through collective organization. This argument was advanced by dissenting psychoanalysts such as Ian Suttie and Karen Horney; biologists including Julian Huxley and Hans Selye; philosophers (e.g. Olaf Stapledon), anthropologists (e.g. Margaret Mead) and physicians (e.g John Ryle and James Halliday).
This introduction and the essays that follow sketch out the emergence of the psycho-social by examining the methods, tools and concepts through which it was articulated. New statistical technologies and physiological theories allowed individual pathology to be read as an index of broader social problems and placed medical expertise at the centre of new political programmes. In these arguments the intangible structure of social relationships was made visible and provided a template for the development of healthy and effective forms of social organization. By examining the range of techniques deployed in the construction of the psychosocial (from surveys of civilian neurosis, techniques of family observation through to animal models of psychotic breakdown) a critical genealogy of the biopolitical basis of modern society is developed.
doi:10.1177/0952695112471658
PMCID: PMC3627511  PMID: 23626408
Psychosocial; social psychology; psychoanalysis; planning; Suttie; Huxley; Halliday
20.  International Institute for Collaborative Cell Biology and Biochemistry—History and Memoirs from an International Network for Biological Sciences 
CBE Life Sciences Education  2013;12(3):339-344.
Memoirs by the 2012 recipient of the Bruce Alberts Award for Excellence in Science Education from the American Society for Cell Biology about the establishment of the International Institute for Collaborative Cell Biology and Biochemistry, which wants to inspire a new era of international scientific cooperation by exposing scientists to diverse learning experiences.
I was invited to write this essay on the occasion of my selection as the recipient of the 2012 Bruce Alberts Award for Excellence in Science Education from the American Society for Cell Biology (ASCB). Receiving this award is an enormous honor. When I read the email announcement for the first time, it was more than a surprise to me, it was unbelievable. I joined ASCB in 1996, when I presented a poster and received a travel award. Since then, I have attended almost every ASCB meeting. I will try to use this essay to share with readers one of the best experiences in my life. Because this is an essay, I take the liberty of mixing some of my thoughts with data in a way that it not usual in scientific writing. I hope that this sacrifice of the format will achieve the goal of conveying what I have learned over the past 20 yr, during which time a group of colleagues and friends created a nexus of knowledge and wisdom. We have worked together to build a network capable of sharing and inspiring science all over the world.
doi:10.1187/cbe.13-06-0108
PMCID: PMC3763000  PMID: 24006381
21.  The Alternating Access Transport Mechanism in LacY 
The Journal of Membrane Biology  2010;239(1-2):85-93.
Lactose permease of Escherichia coli (LacY) is highly dynamic, and sugar binding causes closing of a large inward-facing cavity with opening of a wide outward-facing hydrophilic cavity. Therefore, lactose/H+ symport via LacY very likely involves a global conformational change that allows alternating access of single sugar- and H+-binding sites to either side of the membrane. Here, in honor of Stephan H. White’s seventieth birthday, we review in camera the various biochemical/biophysical approaches that provide experimental evidence for the alternating access mechanism.
doi:10.1007/s00232-010-9327-5
PMCID: PMC3030946  PMID: 21161516
Lactose; Permease; Symport; Transport; Membrane; Membrane protein
22.  Does social medicine still matter in an era of molecular medicine? 
To ask whether social medicine still matters may seem to be in poor taste at a symposium to honor Martin Cherkasky, but social medicine has always had the courage to take on difficult questions. There is all the more reason to do so when its legitimacy is challenged. The extraordinary findings emerging from the human genome project will revolutionize diagnostic and therapeutic methods in medicine. The power of medical interventions, for good and for harm, will increase enormously. However, in the next millennium, as in this one, social factors will continue to be decisive for health status. The distribution of health and disease in human populations reflects where people live, what they eat, the work they do, the air and the water they consume, their activity, their interconnectedness with others, and the status they occupy in the social order. Virchow's aphorism is as true today as it was in 1848: “If disease is an expression of individual life under unfavorable conditions, then epidemics must be indicative of mass disturbances of mass life”. Increasing longevity resulting from major economic transformations has made ours the age of chronic disease. Changes in diet and behavior transform genes that once conferred selective biologic advantage into health hazards. Although disease risk varies with social status, medical care makes an important difference for health outcomes. Access to care and the quality of care received are functions of social organization, the way care is financed, and political beliefs about the “deserving” and the “undeserving” poor. It is a moral indictment of the US that ours is the only industrialized society without universal health care coverage. In educating the American public about the social determinants of health, a goal Martin Cherkasky championed, the very power of the new molecular biology will help make our case. Social medicine is alive and well.
doi:10.1007/BF02344673
PMCID: PMC3455991  PMID: 10924027
23.  Life table methods applied to use of medical care and of prescription drugs in early childhood. 
Life table methods were applied to analyses of longitudinal data on the use of medical care during the first 5 years of life among all 1701 children born in a Swedish semirural municipality. Cumulative proportions of the children who had used particular types of medical care or prescription drugs at least once by certain ages were estimated. By the fifth birthday, 98% had made at least one visit to any physician and 82% at least one visit to a paediatrician. By the fifth birthday at least one prescription for antibiotics had been purchased at a pharmacy by 82%; and 33% had been admitted to inpatient hospital care at least once (excluding immediate postnatal care). Acute conditions and more chronic diseases were also studied using these methods. At least one visit to a physician at a primary health care centre had been made for acute otitis media in 65% of 5 year olds and for atopic dermatitis in 8%.
PMCID: PMC1052816  PMID: 2592902
24.  Multidisciplinary imaging of liver hydatidosis 
Liver hydatidosis is a parasitic endemic disease affecting extensive areas in our planet, a significant stigma within medicine to manage because of its incidence, possible complications, and diagnostic involvements. The diagnosis of liver hydatidosis should be as fast as possible because of the relevant complications that may arise with disease progression, involving multiple organs and neighboring structures causing disruption, migration, contamination. The aim of this essay is to illustrate the role of imaging as ultrasonography (US), multi detector row computed tomography, and magnetic resonance imaging (MRI) in the evaluation of liver hydatidosis: the diagnosis, the assessment of extension, the identification of possible complications and the monitoring the response to therapy. US is the screening method of choice. Computed tomography (CT) is indicated in cases in which US is inadequate and has high sensitivity and specificity for calcified hydatid cysts. Magnetic resonance is the best imaging procedure to demonstrate a cystic component and to show a biliary tree involvement. Diagnostic tests such as CT and MRI are mandatory in liver hydatidosis because they allow thorough knowledge regarding lesion size, location, and relations to intrahepatic vascular and biliary structures, providing useful information for effective treatment and decrease in post-operative morbidity. Hydatid disease is classified into four types on the basis of their radiologic appearance.
doi:10.3748/wjg.v18.i13.1438
PMCID: PMC3319939  PMID: 22509075
Liver hydatidosis; Hepatic cyst; Daughter cysts; Calcified cyst; Pericyst
25.  The morality of abortion and the deprivation of futures 
Journal of Medical Ethics  2000;26(2):103-107.
In an influential essay entitled Why abortion is wrong, Donald Marquis argues that killing actual persons is wrong because it unjustly deprives victims of their future; that the fetus has a future similar in morally relevant respects to the future lost by competent adult homicide victims, and that, as consequence, abortion is justifiable only in the same circumstances in which killing competent adult human beings is justifiable.1 The metaphysical claim implicit in the first premise, that actual persons have a future of value, is ambiguous. The Future Like Ours argument (FLO) would be valid if "future of value" were used consistently to mean either "potential future of value" or "self-represented future of value", and FLO would be sound if one or the other interpretation supported both the moral claim and the metaphysical claim, but if, as I argue, any interpretation which makes the argument valid renders it unsound, then FLO must be rejected. Its apparent strength derives from equivocation on the concept of "a future of value".
Key Words: Abortion • Future Like Ours • Donald Marquis • potentiality • pro-choice
doi:10.1136/jme.26.2.103
PMCID: PMC1733191  PMID: 10786320

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